ST. MAXIMILIAN KOLBE CATHOLIC CHURCH

MIDDLE SCHOOL YOUTH PROGRAM

**We begin in October**

Contact Kia Scott

Faith Formation Office : (818) 991-3915 ext.113

St. Maximilian Kolbe Middle School Youth Ministry is a program designed for youth entering

the 6th, 7th and 8th grades. The youth will engage in fun activities, faith sharing, and creative

learning planned to develop their Catholic faith through social outreach and community based

evenings.

We meet Every other WEDNESDAY from 7:00-8:30pm

in O’Reilly Hall.

(Don’t forget to pick up a calendar in September!)

To register in the St. Maximilian Kolbe Faith Formation program the following information must be on file:

(ALL INCOMPLETE PACKETS WILL BE RETURNED)

A family parish registration on file

A completed and signed registration form

A completed and signed Permission/Medical Release form

A copy of your child’s baptismal certificate

A tuition check for $135 made payable to St. Maximilian Kolbe Church

*ALL STUDENTS MUST BE PICKED UP AT O’REILLY HALL BY A DESIGNATED ADULT. Archdiocesan

regulations do not permit students to wait in the parking lot to be picked up.

Thank you for your cooperation.

SAINT MAXIMILIAN KOLBE MIDDLE SCHOOL (MaxPax)

5801 Kanan Rd., Westlake Village, CA 91362 (818)991-3915

We understand that by registering our children in Faith Formation, we are making a commitment to support the parish by means of regular financial contributions and by volunteering our time to the parish. We are also committing to attend Mass regularly and to participate as required in the Faith Formation programs. Parent Signature____________________________________________________________Date _________________

FAITH FORMATION REGISTRATION FORM 2020-2021 GRADES 6,7, and 8 EVERY OTHER WEDNESDAY from 7:00-8:30pm in O’Reilly Hall

Youth’s Name:____________________________ Sex: M / F Birthdate:_____________ Grade 2018-19:_____

School attending:_________________________ Last Rel. Ed. Grade:____________

Sacraments received: Baptism First Communion Reconciliation

Home Phone: __________________ E-Mail________________________

Address:______________________________________City:__________________________________Zip: ____________ Father’s Name: ___________________Cell #:_________________Work #:______________Religion: ________________ Mother’s Name: __________________Cell #__________________Work#: ______________Religion:________________ YOUTH MUST BE PICKED UP AT THE CLASSROOM. Who is authorized to do this? __________________________________________________________________________________________________

Are there any special needs that should be brought to our attention? (explain here:)______________________________ _____

* Please be aware of the following medical condition(s) for my son/daughter listed here:

Does your child have allergies? Yes_____ No____ If yes, please list__________________________________

PLEASE PROVIDE A COPY OF THE YOUTH’S BAPTISM CERTIFICATE __________________________________________________________________________________________________ 2020-2021 TUITION GRADES 6,7,and 8 FOR OFFICE USE ONLY, PLEASE DO NOT FILL OUT Tuition Fee - $135.00 TUITION PAID______________________________

DATE & CHECK #

Copy of Baptism Certificate AMOUNT DUE

ST. MAXIMILIAN KOLBE CATHOLIC CHURCH

5801 Kanan Road • Westlake Village, CA 91362 • (818) 991-3915 ext. 113

Kia Scott, Youth Minister kia@stmaxchurch.org

FAITH FORMATION PERMISSION SLIP / MEDICAL RELEASE FORM

PARENT/GUARDIAN CONSENT FORM/WAIVER OF CLAIMS AND MEDICAL INFORMATION/AUTHORIZATION FOR PARTICIPATION IN EVENTS AND/OR ACTIVITIES SPONSORED BY ST. MAXIMILIAN KOLBE FAITH FORMATION AT ST. MAXIMILIAN KOLBE PARISH.

PRINT YOUTH’S LAST NAME, FIRST NAME

has my permission to participate in Faith Formation sponsored events and/or programs at St. Maximilian Kolbe Parish for the period from August 01, 2020– August 31, 2021.

I agree to direct my son/daughter to cooperate and to conform to the directions and instructions of the St.

Maximilian Kolbe (SMK) Faith Formation personnel and volunteers in charge of activities, and I understand that

transportation for my daughter/son to Faith Formation sponsored events will be provided by the Participant's

respective Parent/Guardian.

I also give permission for my son/daughter to be photographed at Faith Formation activities and possibly be

posted on the St. Max's Web Site, parish bulletin or on posters at St. Max's.

I, the undersigned, hereby release St. Maximilian Kolbe, agents, representatives from all liability arising out of or

in connection with all St. Maximilian Kolbe Faith Formation activities. For the purpose of this agreement, liability

means all claims, demands, losses, causes or action, suits or judgments of any and every kind that I, my heirs,

executors, administrators or assignees may have against St. Maximilian Kolbe, or that any other person or entity

may have against St. Maximilian Kolbe because of death, personal injury, or illness, or because of any loss or

damage to property that occurs during any activities and that results from any other cause other than negligence.

Should it be necessary for my son/daughter to require medical testing and/or treatment while participating in

events sponsored by St. Maximilian Kolbe Faith Formation in which I (Parent/Legal

medical treatment deemed necessary and appropriate by the physician. I understand that any insurance benefits

that are active have limited application.

I have read and understand the foregoing statements and agree to assume the responsibilities stated above.

Parent/Legal Guardian Signature: Date:

Participant's Address: City: Zip:

Participant's Home Phone #: Participant's D.O.B.:

Parent/Legal Guardian Work Phone or Cell#:

Emergency Contact Person (other than parent):

Emergency Contact's # (home): (work/cell):

Family Physician: Phone #:

Medical Group Coverage: Group/Member Number: